体格检查为指征的双胎妊娠宫颈环扎临床疗效的回顾性队列研究

目的:评估以体格检查为指征的双胎妊娠宫颈环扎的疗效,并与保守治疗组比较妊娠及分娩结局的差异。方法:对我院2015—2019年期间14~26周体检指征的无症状双胎妊娠采用回顾性队列研究。根据是否采用宫颈环扎分为环扎组(n=31)和对照组(n=31),比较两组的妊娠、分娩和新生儿结局。结果:环扎组的分娩孕龄明显晚于对照组;环扎组<34周、<32周和<28周的SPTB发生率显著降低;环扎组从诊断到分娩的时间间隔显著延长;环扎组的剖宫产率增加;环扎组的出生体重较高,围产期死亡率较低,出生5min Apgar评分<7分比例更低(P<0.05)。环扎组新生儿重症监护病房(NICU)入院率、NICU住院时间和新生儿并发增发生率显著低于对照组(P<0.05)。结论:以体格检查为指征的双胎妊娠宫颈环扎组,较保守治疗组,分娩孕周显著增加,从诊断到分娩的时间间隔显著延长,<34周、<32周、<28周自发性早产(SPTB)发生率显著降低,新生儿结局显著改善。

诊断学体格检查实践教学的研究进展

诊断学的体格检查操作手法是医学生最早接触的临床基本技能,也是临床医师获取临床诊断最快速便捷的方式。基于上述的重要性以及其内容繁杂、实践性强、难度大等原因,各大院校积极对其进行了教学改革创新。根据其实践性的特点,增加实践教学比例,注重理论与实践的结合。随着“互联网+教育”的大发展,突破传统的课堂教学,以学生的发展为中心重构教学模式,突破课堂教学的局限性,串联课前-课中-课后,培养学生自主学习能力与习惯。考核评价中,充分发挥同伴督导作用,实施团队考核,改变一考定终身的终结性评价,构建形成性评价体系。本文主要聚焦于上述体格检查实践教学中的改革措施,探寻其改革成效,以期能为广大医学教育者在体格检查实践教学中提供一定的改革思路。

PAL联合思维导图教学法在血液科体格检查临床教学中的应用

目的 探索同伴互助教学(peer-assisted learning,PAL)联合思维导图教学法在血液科体格检查中的教学效果。方法 选择苏州大学附属第三医院2022年1月—2023年3月117名临床医学生作为研究对象,随机分为3组,对照组行传统教学法,试验组1行PAL教学法,试验组2行PAL联合思维导图教学法,每组学生各39名,对3组学生进行不同方式的体格检查教学,教学完成后进行理论知识考核、操作考核和问卷调查。结果 3组间比较,学生在理论知识考核、操作考核以及问卷调查方面的差异均有统计学意义(P <0.05);与对照组比较,试验组1和试验组2的各项得分均更具优势,其中试验组2的成绩优于试验组1,差异有统计学意义(P<0.05)。结论 PAL联合思维导图教学法有助于体格检查技能的掌握和临床思维能力的培养,能够有效提高教学质量。

标准化病人在北京市儿科住院医师规范化培训体格检查和病史采集考站中的应用

目的 探索护士扮演标准化病人在北京市儿科住院医师规范化培训(简称住培)临床技能结业考核中体格检查站及病史采集站的应用与思考。方法 收集两考站标准化病人及专家考官对147名住院医师的评分,进行数据分析。结果 体格检查和病史采集两考站标准化病人评分Cronbach’s α分别为0.922和0.815,可信度高。两考站标准化病人评分分别高于专家评分0.45分和0.63分(P<0.05),与专家考官评分基本一致,准确度较高。结论 标准化病人应用于儿科住培临床技能结业考核取得了良好的效果,可以作为儿科住培考核有效的辅助手段。

住院医师规范化培训中关于体格检查能力培养的思考

体格检查在病情的判断及疾病的诊治中具有不可替代的重要价值,是每名临床医师必须掌握的基本技能。住院医师规范化培训作为医生正式踏入临床工作的第一阶段,是熟练并掌握体格检查的关键时期。然而随着辅助医疗器械的不断进步,大部分住院医师在临床工作中往往对体格检查日常操作和训练不够重视。文章通过分析现阶段住院医师体格检查培养中存在的问题,从激发住院医师内在动力,加强教学医院体格检查培训,完善体格检查考核制度等多角度思考,探讨如何提高住院医师体格检查水平。加强落实住院医师临床工作中体格检查的实施及培训对改善医患关系,提高诊疗水平等医疗工作具有重要的意义。

基于学情分析的教学设计在神经系统体格检查教学中的应用

目的探讨基于学情分析的教学设计在神经系统体格检查(neurologic examination,NE)教学中的应用效果。方法2021年10—12月,选取重庆医科大学同一年级康复治疗学专业63名学生作为研究对象。按照学号排序分为为2组:A组31名,B组32名。A组采用NE的优化教学方案进行教学,而B组则采用NE的传统教学方案进行教学。通过课后现场考核方式,对比2组不同的教学方式,以评估学生在NE运用方面的表现。结果A组的考核得分[(95.355±1.199分)]高于B组的考核得分[(94.219±2.882)分],差异有统计学意义(P=0.046)。结论基于学情分析的教学设计可提升NE的教学效果,因此,教师在NE教学设计过程中应当注重学情分析。

度拉糖肽治疗肥胖2型糖尿病对血糖水平及体格检查指标的影响

目的探讨度拉糖肽治疗肥胖2型糖尿病对血糖水平及体格检查指标的影响。方法52例肥胖2型糖尿病患者,以随机数字表法分为对照组及观察组,各26例。对照组采用调整生活方式、二甲双胍治疗,观察组在对照组的基础上联合度拉糖肽治疗。比较两组患者的体格检查指标[体重、体质量指数(BMI)],胰岛素分泌功能指标[空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)],血糖指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血糖蛋白(Hb A1c)],不良反应发生情况。结果与治疗前对比,两组治疗后体重、BMI均降低,且观察组体重(60.05±2.85)kg、BMI(23.36±1.11)kg/m^(2)低于对照组的(67.85±3.11)kg、(25.68±1.19)kg/m^(2)(P<0.05)。与治疗前对比,两组治疗后血清FINS、HOMA-IR均降低,HOMA-β均升高;且观察组FINS(15.49±2.16)μU/L、HOMA-IR(2.44±0.85)低于对照组的(21.95±3.25)μU/L、(5.26±1.16),HOMA-β(51.14±3.36)高于对照组的(42.01±2.52)(P<0.05)。与治疗前对比,两组治疗后血清FPG、2 h PG、Hb A1c水平均降低;且观察组FPG(5.59±0.53)mmol/L、2 h PG(7.05±0.54)mmol/L、Hb A1c(5.95±0.21)%低于对照组的(8.38±0.87)mmol/L、(11.72±0.61)mmol/L、(8.22±0.36)%(P<0.05)。治疗期间两组患者的不良反应发生率对比,差异无统计学意义(P>0.05)。结论肥胖2型糖尿病患者应用度拉糖肽能有效的降低患者的血糖水平以及体重,改善其胰岛素分泌功能,且具有较高的安全性。

基于“雨课堂”混合式线上直播教学在心脏体格检查课程中的应用效果评价

目的探索“雨课堂”联合腾讯会议混合式直播教学在心脏体格检查课程中的应用效果。方法以心脏体格检查课程为例,选取2019级临床医学、航医、预防医学和心理学四个专业学生为试验组(n=218),采用“雨课堂”联合腾讯会议的混合式直播教学,选取2017级临床医学、航医、心理三个专业学生为对照组(n=143),采用单纯直播教学方法授课。通过随堂测验成绩和问卷调查的形式综合比较两种教学方法的优劣。结果与单纯直播教学相比,基于“雨课堂”联合腾讯会议直播教学形成性评价成绩优于对照组(P<0.01),学习兴趣激发(P<0.01)、基础知识记忆水平(P<0.05)、预习主动检索能力(P<0.01)、培养思维逻辑分析能力(P<0.05)、临床问题解决能力(P<0.01)、汇报表述能力(P<0.01)、团队协作能力(P<0.01)七个方面综合教学效果评价均优于对照组,教学质量评价、学习过程评价、课程满意度评价、临床教学评价、总体评价五个方面教学满意度均优于对照组(均P<0.01)。结论基于“雨课堂”混合式线上直播教学在心脏体格检查理论课教学中可弥补单纯直播教学单向性、教学评价真实性欠佳、学生自控力不足、师生互动不充分、学情分析不足等缺点,有效提高线上直播的教学效果。

网络教学联合团队导向学习教学模式在临床体格检查教学中的应用

探究网络教学联合团队导向学习教学模式在临床体格检查教学中的应用效果。方法 选择2020年6月至2021年6月桂林医学院5年制本科临床医学专业来院实习的实习生80例,采用随机数字表法将其分为对照组和实验组,对照组采用传统带教方法,实验组在此基础上采用网络教学联合TBL教学模式带教,对比两组实习生体格检查考核成绩及教学满意度;结果 较对照组,实验组体格检查考核成绩及教学满意度更高( P < 0. 05) 。结论 新的教学方法可以提高临床医学专业学生体格检查操作水平,规范系统的查体,提高实习教学效果满意率适用于在临床实践教学中的应用。

加强体格检查培训在消化内科住培医生教学过程中的重要性研究

目的 探讨体格检查培训在消化内科住培医生教学过程中的重要性。方法 选取2020年7月至2022年6月在广西医科大学第一附属医院消化内科轮转的住培医生60名,随机分为观察组和对照组,每组各30名。对照组给予传统方法教学,观察组给予腹部体格检查强化培训,比较两组住培医生的理论知识、技能掌握程度及对总体教学的满意度评价。结果 观察组学员的理论知识、技能掌握程度显著高于对照组,差异有统计学意义(均P<0.05)。观察组学员对教学的满意度明显高于对照组,差异有统学意义(P<0.05)。结论 强化体格检查培训模式在消化内科住培医生教学中的效果显著,值得进一步应用和推广。

体格检查微视频在诊断学线上线下混合式教学中的应用效果

目的探讨体格检查微视频在诊断学线上线下混合式教学中的应用效果。方法选取2022年2~7月在教学中的2019级临床医学专业2个班级,按班级分为对照组和研究组。对照组采用传统教学法,研究组采用微视频结合线上线下混合式教学法,比较两组的考核成绩和对教学效果的评价。结果研究组胸部查体、心脏查体、腹部查体和全身查体的理论考试成绩均高于对照组,差异均有统计学意义(均P<0.05)。研究组胸部查体、心脏查体、腹部查体和全身查体的实践考试成绩均高于对照组,差异均有统计学意义(均P<0.05)。在胸部查体、心脏查体、腹部查体方面,两组学生的学习兴趣在60%以上的比例比较,差异无统计学意义(P>0.05)。在胸部查体、心脏及外周血管查体、腹部查体方面,两组学生认为的最难点构成比较,差异均无统计学意义(均P>0.05)。结论基于体格检查微视频在诊断学线上线下混合式教学模式,可提升学生对体格检查技能的掌握,增强临床实践能力,可在诊断学教学中推广应用。

PDCA+标准化病人模式在神经病学体格检查见习中的应用

临床见习是神经病学教学中重要环节,对于培养学生临床思维和临床能力具有重要作用,也是执业医师资格考试中考查学生职业素质、基本技能关键组成部分。神经病学传统的临床能力评价采用纸笔考试,存在评价方法单一、评价不全面的问题,与执业医师考核偏差较大,因此探索神经病学临床见习模式尤为重要。

CBL教学法结合多功能模拟人在肺部体格检查教学中的应用

目的探讨病例学习法(CBL)结合多功能模拟人在肺部体格检查教学中的应用效果。方法选择广西医科大学第一临床医学院2020级“5+3”一体化学习的75名医学生随机分为研究组(n=37)和对照组(n=38)。研究组给予CBL结合多功能模拟人教学法,对照组给予传统教学法,比较两组学生对教学方法的满意度以及肺部体格检查技能考试成绩、总体理论考试成绩。结果研究组学生在提高综合分析能力、促进临床思维、激发学习兴趣、提升肺部体格检查操作水平、改善医患沟通与人文关怀、实践真实情景感的体验以及促进自主学习能力和基础知识掌握方面的满意度均明显高于对照组,差异均有统计学意义(均P<0.05)。研究组学生在肺部体格检查技能考试成绩和总体理论考试成绩方面均优于对照组,差异均有统计学意义(均P<0.05)。结论CBL结合多功能模拟人在肺部体格检查教学中较传统教学法更能增强学生的自主学习和思考能力,提高了学生肺部体格检查操作技能和总体理论考试成绩,提高了教学满意度。

2024 Adult Compendium of Physical Activities:A third update of the energy costs of human activities

Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.

Association of daily sitting time and leisure-time physical activity with body fat among U.S.adults

Background:Prolonged sitting and reduced physical activity lead to low energy expenditures.However,little is known about the joint impact of daily sitting time and physical activity on body fat distribution.We investigated the independent and joint associations of daily sitting time and physical activity with body fat among adults.Methods:This was a cross-sectional analysis of U.S.nationally representative data from the National Health and Nutrition Examination Survey2011-2018 among adults aged 20 years or older.Daily sitting time and leisure-time physical activity(LTPA)were self-reported using the Global Physical Activity Questionnaire.Body fat(total and trunk fat percentage)was determined via dual X-ray absorptiometry.Results:Among 10,808 adults,about 54.6%spent 6 h/day or more sitting;more than one-half reported no LTPA(inactive)or less than 150 min/week LTPA(insufficiently active)with only 43.3%reported 150 min/week or more LTPA(active)in the past week.After fully adjusting for sociodemographic data,lifestyle behaviors,and chronic conditions,prolonged sitting time and low levels of LTPA were associated with higher total and trunk fat percentages in both sexes.When stratifying by LTPA,the association between daily sitting time and body fat appeared to be stronger in those who were inactive/insuufficiently active.In the joint analyses,inactive/insuufficiently active adults who reported sitting more than 8 h/day had the highest total(female:3.99%(95%confidence interval(95%CI):3.09%-4.88%);male:3.79%(95%CI:2.75%-4.82%))and trunk body fat percentages(female:4.21%(95%CI:3.09%-5.32%);male:4.07%(95%CI:2.95%-5.19%))when compared with those who were active and sitting less than 4 h/day.Conclusion:Prolonged daily sitting time was associated with increased body fat among U.S.adults.The higher body fat associated with 6 h/day sitting may not be offset by achieving recommended levels of physical activity.

Alexa,let's train now!——A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging

Background:There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging.Consequently,the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions.In this context,digital and home-based physical training interventions might be a promising alternative to center-based intervention programs.Thus,this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance.Methods:In this pre-registered systematic review(PROSPERO;ID:CRD42022320031),5 electronic databases(PubMed,Web of Science,Psyclnfo,SPORTDiscus,and Cochrane Library)were searched by 2 independent researchers(FH and PT)to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults.The systematic literature search yielded 8258 records(extra17 records from other sources),of which 27 controlled trials were considered relevant.Two reviewers(FH and PT)independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise(TESTEX scale).Results:Of the 27 reviewed studies,15 reported positive effects on cognitive and motor-cognitive outcomes(i.e.,performance improvements in measures of executive functions,working memory,and choice stepping reaction test),and a considerable heterogeneity concerning study-related,population-related,and intervention-related characteristics was noticed.A more detailed analysis suggests that,in particular,interventions using online classes and technology-based exercise devices(i.e.,step-based exergames)can improve cognitive performance in healthy older adults.Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence(≤85%)and monitoring of the level of regular physical activity in the control group.Conclusion:The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall,though there is limited evidence that specific types of digital and home-based physical training interventions(e.g.,online classes and step-based exergames)can be an effective strategy for improving cognitive performance in older adults.However,due to the limited number of available studies,future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.

Association of physical activity with risk of chronic kidney disease in China:A population-based cohort study

Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.

Physical Literacy的本土化:概念厘定、实践反思及应对

Physical Literacy(简称PL)是身体活动与健康促进领域的重要理念,也是新时代学校体育的开拓点之一。长期以来,学界对PL的认知存在争议或模糊不清,导致其在实践中出现了一定的迟滞和偏差,故对相关认知加以厘定与反思具有重要意义。研究认为:(1)从形式逻辑来看,我国学者构建的PL概念在内涵与外延上存在争议或误用。内涵方面,“素养”作为属概念规定了PL的内在特性;“体育素养”的转译窄化了PL的内涵,而译为“身体素养”更能体现PL的身体本源性;作为面向全民的基础生活素养,PL并非核心素养在体育学科的具体化,不宜将其与体育学科核心素养相等同。外延方面,部分PL的外延体系存在偷换“Physical”概念、子素养客体化、子素养相容等问题。(2)在本土实践中,对PL的评价被横向割裂,且纵向衔接不畅;PL的发展情境囿于学校,家庭、社区等校外情境应用不足。针对以上问题,该研究建议未来既要构建横纵贯通的评价体系,也要注意营造多样化的发展情境。

A scoping review of methodologies for applying artificial intelligence to physical activity interventions

Purpose This scoping review aimed to offer researchers and practitioners an understanding of artificial intelligence(AI)applications in physical activity(PA)interventions;introduce them to prevalent machine learning(ML),deep learning(DL),and reinforcement learning(RL)algorithms;and encourage the adoption of AI methodologies.Methods A scoping review was performed in PubMed,Web of Science,Cochrane Library,and EBSCO focusing on AI applications for promoting PA or predicting related behavioral or health outcomes.AI methodologies were summarized and categorized to identify synergies,patterns,and trends informing future research.Additionally,a concise primer on predominant AI methodologies within the realm of PA was provided to bolster understanding and broader application.Results The review included 24 studies that met the predetermined eligibility criteria.AI models were found effective in detecting significant patterns of PA behavior and associations between specific factors and intervention outcomes.Most studies comparing AI models to traditional statistical approaches reported higher prediction accuracy for AI models on test data.Comparisons of different AI models yielded mixed results,likely due to model performance being highly dependent on the dataset and task.An increasing trend of adopting state-of-the-art DL and RL models over standard ML was observed,addressing complex human–machine communication,behavior modification,and decision-making tasks.Six key areas for future AI adoption in PA interventions emerged:personalized PA interventions,real-time monitoring and adaptation,integration of multimodal data sources,evaluation of intervention effectiveness,expanding access to PA interventions,and predicting and preventing injuries.Conclusion The scoping review highlights the potential of AI methodologies for advancing PA interventions.As the field progresses,staying informed and exploring emerging AI-driven strategies is essential for achieving significant improvements in PA interventions and fostering overall well-being.

Effect of Fe_(2)O_(3)on the Structure,Physical Properties and Crystallization of CaO-Al_(2)O_(3)-SiO_(2)Glass

The calcium aluminosilicate-based glasses(CaO-Al_(2)O_(3)-SiO_(2),CAS)with different Fe_(2)O_(3)content(0.10wt%,0.50wt%,0.90wt%,and 1.30wt%)were prepared by traditional melt-quenching method.The glass network structure,thermal and mechanical properties,and crystallization behavior changes were investigated by nuclear magnetic resonance spectrometer,Fourier-transform infrared spectro-photometer,X-ray diffractometer,differential scanning calorimetry and field emission scanning electron microscope measurements.The change of Q^(n)in glass structures reveals the glass network connectivity decreases due to the increasing content of Fe_(2)O_(3)addition,resulting in the increasing of non-bridging number in glass structure.The glass densities slightly rise from 2.644 to 2.681 g/cm^(3),while Vickers’s hardness increases at first,from 6.469 to 6.901 GPa,then slightly drops to 6.745 GPa,with Fe_(2)O_(3)content increase.There is almost no thermal expansion coefficient change from different Fe_(2)O_(3)content.The glass transmittance in visible range gradually decreases with higher Fe_(2)O_(3)content,resulting from the strong absorption of Fe^(2+)and Fe^(3+)ions.The calculated activation energy from thermal analysis results first decreases from 282.70 to 231.18 kJ/mol,and then increases to 244.02 kJ/mol,with the Fe_(2)O_(3)content increasing from 0.10wt%to 1.30wt%.Meanwhile,the maximum Avrami constant of 2.33 means the CAS glasses exhibit two-dimensional crystallization.All of the CAS glass-ceramics samples contain main crystal phase of anorthite,the microstructure appears lamellar and columnar crystals.